Relationship PTSD, or post-traumatic relationship syndrome (PTRS) as researchers have proposed calling it, refers to the response a person may have to one or more exposures to a traumatic event within the context of a relationship with an intimate partner. Within intimate partnerships, the types of relational abuse that have been shown to leave lasting marks are verbal, physical, emotional/psychological, or sexual.
What Is Relationship PTSD?
Relationship PTSD is a proposed subcategory of PTSD, where the main signifier is the type of stressor causing PTSD and the emotional reaction to it. In other words, PTSD that results exclusively from an abusive relationship does not necessarily meet all of the diagnostic criteria for a PTSD diagnosis but may amount to post-traumatic relationship syndrome (PTRS).
PTRS results in some PTSD symptoms, but often with more intensely emotional reactions that often lead to negative social interactions.2 Due to the slow and insidious nature of PTRS, you might not notice symptoms until after the relationship ends. The relational patterns and relationship itself, rather than a single event, become the trauma. You may notice that you have lower self-esteem, blame yourself for relational troubles, or feel more insecure than you once did.2 PTSD and PTRS share their foundational impact: A belief after experiencing the trauma that the world is unsafe.
“When we suffer abuse or neglect in relationships, our brain registers that relationships can be dangerous. If we process and integrate what happened to us, then trauma in relationships can make us wiser. It can help us learn to be more discerning, cautious, protective, and assertive. It can help us learn how to trust skillfully. If we don’t process and integrate what happened and heal our hurt and shame, relational trauma can cause us to avoid intimacy out of fear of being hurt again or a belief that we are not lovable and worthy of intimacy. Alternatively, some people retraumatize themselves by once again engaging with hurtful or neglectful people out of a compulsion to undo past trauma or because being hurt is familiar and something one unconsciously feels one deserves in relationships.” – Dr. Michael McGee, Board Certified in General Adult Psychiatry, Addiction Psychiatry, and Psychosomatic Medicine
What Does Relationship PTSD Feel Like?
Relationship PTSD can be difficult to recognize because it typically happens over a long period of time instead of one traumatic event (the difference between Complex PTSD and typical PTSD). As a result, PTRS can include a pervasive sense of feeling unsafe, out of control, shame or guilt, and thoughts that feel like they come out of nowhere and are difficult to get rid of.
Intrusive Symptoms of PTRS
Intrusive symptoms are symptoms related to re-experiencing trauma, including:
- Thoughts about the trauma that feel like they come out of nowhere
- Flashbacks or feeling like you’re reliving the experience(s) in the form of images, intrusive thoughts, or daydreams
- Nightmares or dreams about the trauma, whether in the context of the dream or just consistent negative or scared feelings in the dreams
- Feeling extreme distress when reminded of the trauma by either the person in the relationship or a reminder of the perpetrator
- Emotional responses that are overblown considering the current emotional stressor
Arousal Symptoms of PTRS
Arousal symptoms are symptoms related to the fear response, including:
- Increased irritability with little or no provocation
- Insomnia, particularly difficulty falling or staying asleep
- Hypervigilance or being “on guard” at all times but particularly when reminded of the trauma
Relational Symptoms of PTRS
Relational symptoms are symptoms that create stress in other relationships, including:
- Difficulty trusting others or socializing
- Loneliness or isolation
- Jumping into a new relationship
- Shame, guilt, or self-blame—all of which are common in trauma bonding
- Sexual dysfunction
- Feeling that the world is unsafe
What Causes Relationship PTSD?
The trauma that causes relationship PTSD could be from physical, emotional, sexual abuse, but unlike traditionally-diagnosed PTSD, occurs only with a partner within an intimate relationship rather than witnessing or experiencing a traumatic incident occurring outside of the context of an intimate relationship.
What constitutes a traumatic exposure that may result in PTSD from an abusive relationship? There is not just one incident, but rather several incidents over the course of time in an abusive relationship that lead to PTRS.
Any incidents of abuse or relationship trauma may lead to PTSD, including:
- Unhealthy relational patterns: Belittling, gaslighting, controlling, or criticizing repeatedly can constitute emotional abuse.
- Physical abuse or domestic violence: Punching, hitting, or any form of purposefully injuring or attempting to cause harm to a partner is abuse.
- Sexual abuse: Even within the context of an intimate relationship, any form of nonconsensual sex, or sexual coercion, is considered abuse.
With this in mind, everyone responds to traumatic exposures differently, and what you may experience as traumatic may not be traumatic for the next person.
Healing From Relationship Trauma
If anything you’ve read about relationship PTSD sounds familiar to you and your experience, know that there is help available. Because relational, interpersonal trauma is more likely to lead to a clinical PTSD diagnosis than non-interpersonal trauma such as a natural disaster, seeking out an appropriately trained and trauma-informed therapist is crucial. Rates of suicide attempts or ideation, self-harm, and substance abuse are elevated in studies of people with PTRS, so it’s important to seek appropriate help as soon as you recognize an issue.
McGee also mentions, “The way to heal from relational trauma is to engage in safe, loving relationships with safe, loving people. It is true that ‘love heals.’ We heal our relational love wounds through a combination of loving ourselves and borrowing the love of others. When we engage in loving and being loved, we create the opportunities for ‘corrective emotional experiences’ that cause a revision of our emotional/relational limbic system. There is a revision of our sense of self as lovable people and a development of the capacity to feel safely and harmoniously connected to others.”
The model for treatment outlined by the author who coined the term “post-traumatic relationship syndrome” argues the best treatments for relationship PTSD are:
- Prolonged Exposure (PE): PE is “typically provided over a period of about three months with weekly individual sessions,” each 60 to 120 minutes long. In PE, you will be exposed to trauma-related stimuli that are gradually more difficult. The goal is that you are able to approach trauma-related situations without triggering your body’s fear response.
- Cognitive Processing Therapy (CPT): CPT is a 12-week long therapy protocol wherein your therapist will help you challenge the beliefs associated with your trauma.
- Eye Movement Desensitization and Reprocessing (EMDR): EMDR for PTSD works to reduce the intensity of trauma-related memories. In EMDR, your therapist will have you focus on the trauma briefly while using bilateral stimulation—this could be tapping, tracking the therapist’s fingers with your eyes, or a noise in one ear and then the other. The total number of sessions averages between 6-12.
- Trauma-Focused CBT (TF-CBT): Trauma-Focused CBT is another treatment model that is typically used with children and adolescents suffering from the consequences of interpersonal trauma or PTRS. TF-CBT works with the child or adolescent and their caregivers to alleviate trauma symptoms over the course of 8-25 sessions.
Helping a Partner Who Has Experienced Relationship Trauma
McGee encourages, “If you are the partner of someone with a significant love wound or ‘relational PTSD,’ I recommend couples counseling. This creates a safe holding space for working through distortions, misperceptions, and miscommunications. It also creates a safe practice forum for developing the capacity for emotional intimacy. Your partner may misperceive you at times through a trauma-based negative schema. They may suffer extreme reactions to normal misattunements. Take their reactions seriously, but not personally. Practice patience, understanding, and compassion. Schedule times to talk about conflicts when you and your partner are calm and collected and not in the heat of the moment.”
What’s the difference between PTRS and PTSD?
Traumatic stress after an abusive relationship can look a little different from typical PTSD.
A diagnosis of PTSD requires symptoms in four categoriesTrusted Source:
- re-experiencing
- avoidance
- arousal and reactivity
- cognition and mood
People living with PTSD often shift between two different states. Flashbacks, memories, and intrusive thoughts bring the trauma into your conscious awareness, returning you to a state of crisis. In response, you begin avoiding everything to do with the traumatic event, generally in order to avoid triggering those memories.
PTRS doesn’t involve the same avoidance that characterizes PTSD.
With PTRS, you may find yourself unable to avoid memories or reminders of the traumatic relationship, and you remain fully aware of what happened. Since you can’t numb yourself to the distress, you might cope by trying to manage your emotional response instead.
Maybe you talk or journal about what happened. Or, you try to replay and reframe the situation, but your efforts leave you doubting yourself. You may even attempt to navigate loneliness (and replace those painful memories) by seeking out a new partner right away.
These emotion-focused coping strategies are great ways to deal with some types of distress, but they don’t always promote healing in the immediate aftermath of abuse.
They might instead keep the trauma overwhelmingly fresh in your thoughts, making it even harder to find relief.
PTRS differs from PTSD in a few other key ways:
- A diagnosis of PTSD involves experiencing or witnessing a threat of physical harm, including injury or death. You can experience PTRS without ever facing physical harm.
- PTSD diagnostic criteria don’t list any specific symptoms for people who experience relationship trauma, while symptoms of PTRS center around relationship trauma and its long-term effects.
- Key symptoms of PTRS include rage, horror, and fear toward the abusive partner. With PTSD, you might experience anger or rage, but this isn’t a key symptom for everyone.
Final Thoughts on Relationship-Based PTSD
Relationship trauma can develop as a result of harmful relationships, and the aftermath can be psychologically and physically devastating. If you are in an abusive relationship, it’s important to remember that abuse is never the fault of the person experiencing it. Working with a mental health professional can be an essential step to beginning to heal from trauma. Remember that support is available through advocacy organizations like the National Domestic Violence Hotline.
